Rx: Read

By LYNDA RICHARDSON

Published: April 17, 2011

CORRECTION APPENDED

IT was another hectic morning in the pediatric clinic of Bellevue Hospital Center, where the clamorous waiting room had been transformed into a reading room. Toddlers sat crowded onto blue mats as volunteers read loudly from children's books. Dr. Perri Klass weaved in and out of the steady traffic of strollers. She hovered over one mat, where a 1-year-old named Bella used a pincer grip to lift a board book titled ''Let's Go to the Park,'' pointed at pictures and then looked at her mother.

''Her ability to communicate and draw her mother's attention is totally on target,'' Dr. Klass said, nodding. ''If you're a doctor, you don't have to wonder about her communication skills. And her fine motor skills are good.''

The children's book, as it turns out, is a valuable tool for both parent and doctor. ''Using the book, the pointing and identifying, is a way of helping parents understand the job of naming the child's world, helping the child learn that everything has a name,'' Dr. Klass said. ''It's a big cognitive, developmental and communicative step. It's a huge step for a baby.''

Bellevue is a leading laboratory in the promotion of early childhood literacy. Doctors at the hospital prescribe books as routinely as immunizations as part of a national nonprofit program called Reach Out and Read. They are taught to use those books to assess a child's development, including fine motor skills in the way a child holds the book. Doctors also evaluate language, social and emotional skills based on the way the child communicates about the book with parents.

By melding reading into the practice of pediatric medicine, Reach Out and Read aims to bring about a new understanding of what the pediatrician's role should be, said Earl M. Phalen, the organization's chief executive, who was visiting the Bellevue pediatric clinic from the program's Boston headquarters on a recent morning. ''We're absolutely trying to change the way doctors are trained,'' he said, ''because we know and pediatricians know that one of the most important things they can do to impact the long-term health of their patients is to make sure their patients are literate.''

Mr. Phalen, an energetic man who was a foster child, has been mentoring schoolchildren, many of them poor, since he was a Harvard law school student in the early 1990s. He said nearly half of the funds for Reach Out and Read come from the federal government, and it has been incorporated into more than 80 percent of the nation's pediatric residency programs. It is part of the curriculum at New York University, where Dr. Klass teaches pediatrics and journalism (she contributes a monthly column to The New York Times on youth and medical issues) and lectures on promoting literacy in primary care. She is the national medical director of Reach Out and Read.

The program's strategy was developed in Boston in 1989. Nearly 7 million free books are handed out a year, to 3.8 million children, most from low-income families. Patients receive books at every checkup from 6 months to 5 years of age. Doctors are trained to give age-appropriate advice to encourage parents to read to their children.

''From everything we know about brain development, children can learn skills that lead to reading right from birth, and it's important especially in the first three years of life,'' said Dr. Barry Zuckerman, who along with Dr. Robert Needlman founded Reach Out and Read. ''It's a special opportunity for pediatricians because pediatricians see children frequently and parents value their suggestions.''

Increasingly, research has supported the idea that children should be exposed to a language-rich environment as soon as they are born because it can significantly improve cognitive and language development and readiness for school.

In an influential 1995 study by child psychologists at the University of Kansas, vocabulary growth was shown to differ sharply by class. By age 3, children whose parents were professionals had vocabularies of about 1,100 words, and children whose parents were on welfare had vocabularies of about 525 words. The researchers concluded that the size of each child's vocabulary correlated most closely to the number of words the parents spoke to the child. Low-income children hear as many as 30 million fewer words than their more affluent peers before kindergarten.

And it's not only the quantity of the words but the quality that counts, said Harriet Meyer, head of Ounce of Prevention, a nonprofit organization.

''You find mostly directional language among the poor -- 'Go over there,' 'Sit down' -- and not those questions so common in middle-class families, like 'What shape is the Cheerio? Is it round or spherical?,' representational versus directional, open-ended questions. Children learn there's a much bigger world than the small one they appear to live in. ''

The literacy problem is compounded by the lack of children's books in low-income homes, where reading is often not a parental priority.

''When we talk about developing literacy,'' said Jacqueline Jones, senior adviser for early learning at the United States Department of Education, ''we have to understand it has to be grounded in a rich language understanding so that young children, and infants, need to be surrounded by people talking and talking a lot.''

This article has been revised to reflect the following correction: An article last Sunday in the special Education Life section about the national nonprofit program Reach Out and Read, in which doctors promote early childhood literacy, misstated the area where Bellevue Hospital Center is located. It is the East 20s, not Lower Manhattan.